台灣地區視網膜病變的盛行和衝擊－相關文獻的回顧

Impact and Prevalence of Retinopathy in Taiwan-Literatures Review

陳世真(Shih-Jen Chen) ； 程景煜(Ching-Yu Cheng)

《中華民國眼科醫學會雜誌》 48卷3期 (2009/12) Pp. 237-244

https://doi.org/10.30048/ACTASOS.200912.0001

摘要

目的：了解台灣地區主要視網膜病變的盛行率，其相關危險因子和預防的方法。
方法：相關文獻的回顧。
結果：有三到四成的成人視障人口，是導因於老年性黃斑部退化，糖尿病視網膜病變和高度近視視網膜病變。這三者合起來，是造成目前台灣失明的首因。老年性黃斑部退化的盛行率為11%（大於65歲以上人口），和西方國家的報告相當；年齡為其危險因子，吸煙並沒有關聯；預防的方法目前以服用維他命C、E和鋅為主。糖尿病視網膜病變的盛行率為15~45%（糖尿病患的人口）；危險因子為高血糖，高血壓，和長期糖尿病史；一年一次的散瞳眼底檢查能減少失明的發生，是最符合經濟效益的預防之道。高度近視視網膜病變的盛行率為45%（高度近視的病人）；危險因子為年齡和近視度數；預防在於延緩學童時期近視的發生和度數的加深。藉由針對特殊族群（糖尿病，65歲以上老人，高度近視）施行定期的眼科檢查，尤其是散瞳眼底檢查或照相，有助於早日發現高危險群，施以較密集的追蹤和衛教，來提高病人的意識，以期能夠在病變發生時盡早就醫。
結論：這三大視網膜病變中，在台灣地區，以糖尿病視網膜病變的流病資料，包括盛行率和發生率，危險因子和經濟效益評估，最為完備，提供未來預防上的參考和方向。老年性黃斑部退化尚無發生率的資料，而高度近視視網膜病變則只有醫院的調查報告。我們尚需大型的社區流行病學調查，來幫助我們了解造成視力障礙的衝擊和原因，探討致病的危險或保護因子，以提供未來公共衛生的預防政策。

並列摘要

Purpose: To understand the impact of major retinopathy, including its prevalence, associated risk factors and prevention, in Taiwan.
Method: Literatures review.
Result: Retinopathy is the leading cause (30 to 40%) of visual impairment in adults in Taiwan. Adding all together, age-related macular degeneration (AMD), diabetic retinopathy (DR) and high myopic retinopathy are the number one cause of blindness. The prevalence of AMD among the elderly people (≥ 65 years) is 11%, which is comparable to the rate in western people. Age is the only significant risk factor for AMD, while smoking is not. The prevention method may involve oral vitamin C, E and zinc. The prevalence of DR is 15 to 45% in the diabetic patients. The risk factors are high blood sugar, hypertension and the duration of diabetes. Annual dilated-pupil retinal examination could decrease the risk of blindness and is the most cost-effective screening schedule. The prevalence of high myopic retinopathy is 45% based on the hospital-based surveys. The risk factors are age and myopic refraction. The prevention is to delay the age of onset and slowdown the progression of myopia in school age children. Because of the lack of efficient preventive methods and the progressive nature of the retinopathy, early detection by regular pupil-dilated fundus examination or photography among the susceptible groups (elderly people, diabetic patients and high myopics) may identify subjects at high risk for retinopathy, educate the patients awaken to retinopathy, and prompt early treatment.
Conclusion: Among the community-based epidemiological studies of retinopathy in Taiwan, DR had been investigated thoroughly and data are available on prevalence, incidence, associated risk factors and economic evaluation. This information will help guide the direction and shape the way in the future preventive intervention for DR. The incidence data and associated risk factors were pending for AMD. For high myopic retinopathy, community-based studies are still lacking. We are still in need of population-based studies because they play important roles in providing our key country's epidemiologic data for understanding the impact of vision loss, its causes, risk and preventive factors, and for planning of public health interventions.

並列關鍵字

retinopathy ； epidemiology ； high myopic retinopathy ； age-related macular degeneration ； diabetic retinopathy